Safely Withdrawing from Anti-Depression and Anti-Anxiety Medications

NOTE: Some women decide that the benefits of anti-depression and anti-anxiety medications outweigh the risks and will continue taking these medications. This FAQ is for women who feel that the risks and harmful effects of anti-depression and anti-anxiety medications outweigh the benefits for them, and they have decided to safely withdraw from the medications. Never stop taking anti-depression or anti-anxiety medications suddenly.

What are the reasons that women decide to go off their anxiety or depression medications, and reasons they take them in the first place?

The focus of this FAQ is on Selective Serotonin Reuptake Inhibitors (SSRIs), a class of medications prescribed for anxiety and depression, and Benzodiazepines (e.g., tranquilizers, sleeping pills), a class of medications prescribed for anxiety, muscle pain, sleep problems and sometimes, incorrectly, for depression. In fact, Benzodiazepines are central nervous system depressants and, if taken for long enough, will likely cause depression. Benzodiazepines (benzos) are intended only for short-term treatment of acute conditions, yet many women are taking these medications for well over two to four weeks, sometimes even for years. As for SSRIs, many women are prescribed these anti-depressants for an indefinite period and may decide to stop taking them for a number of different reasons.

Why do so many women start taking anxiety or depression medications in the first place? In Canada prescription rates for antidepressants rank among highest in the world, with two-thirds of prescriptions going to women (OECD, Health at a Glance 2013). Many women are prescribed anxiety and depression medication because the medications are reasonably accessible and seemingly provide a treatment option that is, at least in the short term, less expensive than talk therapy and less work than other effective options, such as exercise and meditation. However, the choice to take these medications is not always for short-term relief. Some women report that they have exhausted non-drug approaches to treating their depression and anxiety, and that these medications help on an ongoing basis.

These medications are often prescribed for what may be natural reactions to the stress of balancing women’s work and family lives or coping with a recent loss or upset. In such cases, the medications may provide relief for symptoms in the short term, but they do not cure anxiety or depression, and there may be underlying causes of depression and anxiety to explore. This is especially true for women who have experienced trauma in their lives. On the other hand, some women report that these medications help them cope with unexplained depression and anxiety that is not apparently linked to a specific event or cause.

Life can feel especially burdensome in times of adjustment to normal life events, such as childbirth or menopause, or unexpected challenges such as grief or chronic illness or pain. Increasingly, events that were once called sadness, mild depression or anxiety are now considered medical problems and disorders resulting from a “chemical imbalance” in the brain and requiring a pharmaceutical top-up. While there is a widely held belief that SSRIs, for example, are chemically necessary for some brains to correct a “serotonin deficiency,” there is no valid medical research to confirm this. We know that some women whose life circumstances expose them to higher levels of stress, including Aboriginal women, seniors and those living in poverty or who have a history of trauma, tend to be prescribed anti-anxiety medication more often than others. The social, cultural, economic and life stage factors that contribute to feelings of anxiety and depression are often overlooked or downplayed when determining treatment options.

Both benzodiazepines and SSRIs affect brain chemistry in either a sedating (benzodiazepines) or stimulating (SSRIs) way; so, at least initially, the medication may feel like a welcome relief from severe distress. These medications do not, however, cure the depression or anxiety even though they can make what seemed impossible feel more bearable for a time. Some people may not notice any change when taking the medication but may not have been offered a feasible alternative. Some women feel that the help they are getting outweighs any side-effects of the medication and they choose to keep taking them.

Regardless, there may come a time when some of the side-effects start to feel more troublesome. For SSRIs, these include: agitation, restlessness, sexual problems, stomach upset, and weight loss or gain. For benzodiazepines, common side-effects include drowsiness, dizziness, lack of coordination, muscle pain, cognitive problems, increasing anxiety, panic attacks, problems with sleep and sexual problems. Also, because of the sedating effects, both types of medication also contribute to falls, especially for elderly women, resulting in hip fractures or other serious health problems. These problems may start to feel even less worth it if you are beginning to doubt the usefulness of the medication and want to try to stop taking it. Women who are thinking of getting pregnant or are already pregnant may choose to go off the medications because of concerns for the health of the baby. Other women may simply want to try to find non-medication solutions to deal with anxiety or depression; or to know how they will feel not taking the medications.

When is a good time to start the withdrawal process?

Ideally, it is best to find a time when you are less stressed generally, and not at a time when there is a lot of change in your life (good or bad). If you are on several psychiatric medications, it is best to withdraw from one at a time. This is a good time to avoid alcohol or recreational medications and not a good time to also quit or take up smoking. Take the time to read up on the topic and try to find a health care provider who can support you through the process and help you develop a withdrawal schedule that meets your needs. If you are unable to find a health care provider who can do this, a number of helpful resources are offered below as well as a supportive online community. Note: tapering from SSRIs and benzodiazepines are two very different processes. See below for Dr. Glenmullen’s book on SSRI withdrawal and the Ashton Manual for withdrawal from benzodiazepines.

What is tapering and why can’t I stop taking my medication ‘cold turkey’?

Never stop taking your antidepressants or anti-anxiety medications suddenly, no matter the dose, nor how short the time on them, nor the lack of noticeable effect. This can be very dangerous. It is an immense shock to the system to try to stop taking medication suddenly and may actually extend the time it takes to withdraw completely from medication.

Tapering is when you gradually take less medication in carefully scheduled doses, and allow the body to gradually get used to going without. The tapering plan depends on the types of medication you are taking. For SSRI withdrawal the tapering plan may happen relatively quickly while monitoring your symptoms whereas for benzodiazepine withdrawal, you need to taper slowly using a longer-acting benzodiazepine such as Valium as a substitute. See below for Dr. Glenmullen’s book on SSRI withdrawal and the Ashton Manual for withdrawal from benzodiazepines. If possible find a supportive health provider before you begin tapering to help you develop a plan and to monitor and support you through the process and into recovery. Note that you are unique and each person’s body reacts differently to medication withdrawal. It is important to be able to adapt a tapering plan to your needs to minimize and prevent withdrawal symptoms.

What are the withdrawal symptoms?

Remember that everyone’s experience is different and many withdraw with manageable symptoms. As mentioned, the tapering process is different depending on the medication you are tapering from and depending on how your own body reacts to the process.

Because the medications act at different places throughout the body, the symptoms can be both physical and mental [For a full list of symptoms: Benzodiazepines and SSRIs]. These symptoms may be uncomfortable but are not usually dangerous. You may find it helpful to keep a daily diary of moods and physical sensations to keep track of how your body is tolerating the tapered dose, and slow down the tapering schedule if the symptoms are severe. When it comes to mental health, and perhaps in health more broadly, you are the expert in the situation; the health care provider is there to support you and help you identify problems. You are the only one living in your body and the only one who can truly know what is working and what is not.

While you are withdrawing, it is helpful to keep in mind that a reaction such as anxiety that may emerge within days to weeks of adjusting medication; this is most likely because of the medication and not a recurrence of the reasons you started taking the medication. Physical complaints (such as dizziness, flu-like symptoms and abnormal sensations) are not typically found in relapse of anxiety or depression.

Withdrawal symptoms are the body’s way of trying to readjust to the pre-medication state and, sadly, there are no shortcuts or additional medications to make this easier. The only thing that can be done is to pace yourself and try not to be discouraged; for many people it gets worse before it gets better. Drinking lots of water and eating a healthy diet can help move the residues of the medication out of your system and give your body the building blocks to heal. Doing exercise that is not too strenuous, such as swimming, can also be helpful.

How long does it take to fully withdraw?

It is highly individual. It can take weeks or months, and is best not to rush it. With determination, patience and acceptance, however, it can be successful. After you withdraw, you may continue to have withdrawal symptoms because it takes a long time for the body to fully clear itself of psychiatric medication.

What can you do if you are going through psychiatric medication withdrawal?

The following suggestions are from the Network Magazine article “No Quick Fix”

Know that what you are experiencing is real. There is a small but vocal community of people who document psychiatric drug withdrawal symptoms. The information is out there. You are not alone. Check out the resources below.

You have nothing to be ashamed of regarding having mental health struggles, being on medications, or having a hard time getting off medications.

If your health care providers don’t believe that you are having withdrawal symptoms, try to find a professional who is willing to work with you. It is hard to be your own advocate when you are in the throes of psychiatric drug withdrawal; you know yourself best.

Try to find a friend or family member who can help you assemble information, act as a sounding board and accompany you to appointments.

Chart your symptoms.

Be clear and concise with health care providers. Respectfully offer concrete suggestions and be willing to compromise within your limits.

Don’t give up on yourself. Don’t ever doubt that you deserve to be as well as you can possibly be.

Remember that withdrawal is highly individual and you need to find what works best for you. While you have nothing to be ashamed of, people may say that your withdrawal symptoms are due to worsening mental illness, so be careful who you talk to about it and try to find a supportive, listening ear.

What happens after the tapering is finished?

Healing from dependence on psychiatric medication is not a linear process. Some days will be good and some days will be bad, but recovery is happening even on bad days. On good days, be realistic and set goals that are reasonable; don’t try to do everything at once. Once you are off the medication, it will take time for the brain to heal and re-adjust. In coming off benzodiazepines, some women experience delayed shock and grief—the feelings that were blocked by the medication. It is helpful to maintain regular checkups with a health care provider and seek out alternatives to medication therapy for depression or anxiety. Note: people who have withdrawn from psychiatric medications should avoid fluoroquinolone antibiotics like Ciprofloxacin because they have been shown to trigger psychotic episodes.

What are some alternatives to medication therapy for depression and/or anxiety?

Here are some examples of alternative that many have found helpful to prevent and alleviate the symptoms of depression and anxiety:

Will my anxiety and/or depression return?

It may or it may not. Some will have been on medication long after the condition would have gone away on its own. About half of those who had an improvement with treatment, will see depressive symptoms come back in the next year. It is important to have a plan in place to help mitigate the return of symptoms, such as any of the alternatives noted above.